Comprehensive Sickness Insurance (CSI) is required by law for EEA and Swiss students, self-sufficient individuals, and their family members staying in the UK with them. You must consider why a person did not have CSI if they did not have it.
Does Ehic count as comprehensive sickness insurance?
You can use a European Health Insurance Card (EHIC) as proof of Comprehensive Sickness Insurance, according to the EEA(QP) form, but only if you declare that you do not intend to reside in the UK permanently.
While this may be beneficial to some, many others would prefer the ability to stay in the UK permanently if chances arise. However, the declaration is not legally enforceable in any way, and it is debatable whether the Home Office’s position is correct. Because there are no settled cases on the subject, it is impossible to say with certainty when an EHIC will be valid.
An EHIC obtained by another member state (not the UK) can be used when applying for permanent residence permits. European Economic Area nationals: a policy document from the Home Office Officials are instructed by certified individuals:
EHIC or E111 applications for a document certifying permanent residence or a permanent residence card are available.
These applications do not require a statement of intent because the permanent residency stage determines if the applicant has previously obtained a right of permanent residence in the United Kingdom.
As a result, the applicant’s future plans are irrelevant. In these cases, applicants merely need to establish that they possessed an EHIC (or an E111) for the entire five-year period of continuous residence.
If the applicant presents an EHIC that does not cover the entire period relied on or does not have a valid from date, they must also produce evidence from the issuing body verifying that they had a valid EHIC card during the time period relied on.
So, while an EHIC cannot be used to get a residence certificate unless the residence is temporary, once a person applies for permanent residence, continuous EHIC coverage will suffice, and intentions will become irrelevant.
What is comprehensive sickness insurance British citizenship?
So, what exactly is Comprehensive Sickness Insurance? In a nutshell, CSI is a sort of health insurance that EU nationals who were not economically engaged such as students or self-sufficient individuals were required to get while residing in the United Kingdom.
Do I need comprehensive sickness insurance for pre-settled status?
Following the end of the post-Brexit transitional phase on January 1, 2021, the UK will implement a new immigration system. This means that all EU-issued documentation, such as permanent residency cards, will no longer be valid for EEA and Swiss nationals and their family members.
Those who plan to stay in the UK by the end of 2020 must apply for immigration status under the EU Settlement Scheme.
When applying for settled status under the EU Settlement Scheme, proof of comprehensive sickness insurance is not required.
Under the plan, an applicant will be granted settled or pre-settled status. Those who have lived in the United Kingdom for at least five years will be granted settled status, or indefinite leave to remain. Those who have lived in the United States for less than five years will be granted pre-settled status, which will allow them to apply for established status after they have met the requirements.
Under the scheme, current holders of documents certifying their permanent residency can exchange it for established status.
Do Phd students need CSI?
Following the Brexit referendum, the question of Comprehensive Sickness Insurance (CSI) and residency for EU students has become a hot topic. For the past five years, Bethan Ovens has advised the LSE on the CSI requirements for dual-EU/Non-EU nationals exercising their right to free movement. She claims that dual-EU/Non-EU students frequently do not have access to a European Health Insurance Card (EHIC), and that the need for CSI is often not discovered until their dependant is denied a residency permit.
EU students were given advice in many institutions throughout the sector well before the referendum’s conclusion, recommending them to get an EHIC before traveling to the UK. EHIC satisfies the CSI requirements as long as the individual intends to stay in the UK temporarily and has a valid card throughout their stay. You can often discover this in your orientation information or on institutional webpages.
Universities are likewise unlikely to include the question “Do you have CSI?” in the application process because it is unrelated to the academic criteria of an offer. Non-EU students applying for Tier 4 do not pay the Immigration Health Surcharge (IHS) until after they have applied for their visa, but more on that later.
The government assumes that both EU nationals and non-EU nationals study the material provided prior to traveling so that they are aware of what is required for their individual circumstances.
People’s situations fluctuate, of course.
Not everyone who came as a temporary migrant considered applying for permanent residency.
When many students began their studies, we could not have imagined that the United Kingdom would leave the EU.
We cannot, however, assume that everyone was aware of the CSI requirement.
I recently met an undergraduate student who had been studying in the UK for nine years and had had her EHIC card and medical insurance up to date.
In 2015, the Immigration Health Surcharge (IHS) was implemented. The IHS costs £150 per year of study plus the additional time on their visa for students. As a result, an LSE student pursuing a four-year PhD would have to pay an additional £675 in addition to the visa application price for the IHS. Their dependents will have to pay the same sum as well. Because the IHS is paid in full at the time of filing the visa application rather than on a yearly basis, many students were unaware of the additional expense when it was introduced in 2015. The IHS is repaid if a visa application is denied. Tier 4 students, on the other hand, will not receive a refund on the IHS if they drop out of their program or have to interrupt their studies.
While the amount a Tier 4 student must pay for healthcare in the UK is apparent, there are other legal conditions they must complete in order to study in the UK. Interviews to verify they are a legitimate student, evidence of their qualification, and proof of sufficient money in a manner specified by the UKVI are among these requirements. Rules change regularly, and this has an unanticipated influence on students. For example, a change in the rules in April 2016 obliged some LSE students to return home in the summer to apply for a new Tier 4 visa in order to finish their study.
It might be argued that the IHS is discriminatory, however on balance, the Tier 4 immigration path is more restrictive, and since its inception in 2009, non-EU students have been subjected to regulation modifications every year. To get a student’s viewpoint on the matter, EU students may want to chat with one of their Tier 4 peers.
As things stand, EU citizens’ entitlement to study in the UK has not changed, and they are not obliged to get papers proving their right to live in the UK as an EU citizen. Students and their families, on the other hand, must ensure that they have CSI throughout the duration of their studies. The UK Council for Foreign Student Affairs (UKCISA), the national advisory body for international students and those who work with them, is a great source of assistance. They keep their advise up to date, not only on CSI but also on the future implications of tuition prices.
The greatest way we can support our international students is an almost daily topic of conversation among my network of visa / international student counselors in higher education.
International student advice teams are upgrading their skills to obtain a better awareness of the criteria for EU students, and institutions are sharing best practices and relationships. Our guidance for EU students is updated on a regular basis. It may be argued that this is being done in a reactionary fashion, but due to the way immigration regulations are clarified, this is often the nature of our work.
The laws of the Office of the Immigration Service Commissioner require international student advisers to only provide advice within the scope of our level of training.
If your foreign student adviser is unable to provide extensive guidance on your specific question, do not be frustrated.
We may not have all of the answers, but we can direct you to reliable outside sources of information and help. Again, as with Tier 4 students, an institution may not be able to give all of the documents you seek, but we will provide whatever information we can.
We have no idea what the future holds.
When change occurs, we will do everything we can to help EU students in the same way that we have done for non-EU students for many years.
After spending time in China and Eritrea, Bethan Ovens has worked as an international student adviser since 2008. She is currently in charge of the LSE’s International Student Visa Advice Team.
How do I get an S1 form?
Basic state services are free once you’ve registered for healthcare, however there are some items that patients must pay for. Prescriptions, for example, normally require payment of some sort – either a reduced or full amount.
UK citizens commonly use one of the following methods to access the Spanish national health system:
- If they are employed or self-employed in Spain and pay social security obligations, they are entitled to healthcare.
- registering an S1 form supplied by the United Kingdom with the Social Security Office (see ‘UK-funded healthcare: obtaining and using an S1 form in Spain’ below)
- If they’ve resided in Spain for 5 years, they’re entitled to healthcare as a permanent resident.
- Using an EHIC or GHIC for temporary stays while studying or working as a posted (detached) worker
Is Sweden in the EEA?
Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, and Sweden are among the countries represented.
What is a comprehensive deductible?
A comprehensive deductible, as a reminder, is the amount you must pay out-of-pocket when submitting a comprehensive insurance claim. For example, if a hailstorm damages your automobile $5,000 and your deductible is $1,000, your insurance company will only pay $4,000 for repairs.
Who needs CSI?
Following two policy changes, the first in May 2020 and the second in September 2020, EEA nationals who wish to become British citizens must now answer the following questions: how can I demonstrate that I have Comprehensive Sickness Insurance (CSI)?
The Home Office will now consider the previous ten years when assessing citizenship applications, and if you were in the UK during that time, they will determine whether CSI was required. Your citizenship application may be denied if it was required and you did not have it.
For settled or pre-settled status, CSI is not necessary. This article does not apply to such types of applications. The policy change is related to the requirement for good character in citizenship applications. It is considered a breach of UK immigration law if you did not have CSI when it was required. Those who have broken UK immigration law in the last ten years are unlikely to achieve the good character criteria.
Only EEA nationals who have not worked continuously for 5 years are needed to complete CSI. You do not need to read any further if you have always worked and paid National Insurance contributions.
If you have had long periods of unemployment, have never worked, or have studied in the United Kingdom within the previous ten years, you should consider whether you need to show CSI before applying for citizenship.
You do not need to show that you had CSI if you can establish that you have had permanent residency at any point in the past.
Marcin, an EEA national, arrived in the UK with his parents when he was 15 years old in 2012. He is now 22 years old. Since the family’s arrival in the United Kingdom, his father has worked nonstop. Marcin went to school until he was 18 years old and is now a student at university. He’s never worked in the United Kingdom. In 2019, he received settled status and plans to apply for citizenship.
Marcin may believe he requires CSI as a student. He can, however, establish that he obtained permanent residence in 2017 as a family member of an EEA national (his father) who has worked in the UK for 5 years. CSI is no longer required once you have obtained permanent residence, even though he is no longer a family member (as he is above 21). It makes no difference that he has never obtained a document proving permanent residence because permanent residency is gained automatically.
Javier arrived in the UK in 2010 and worked until 2016, when he had to stop working to care for his children. Since then, he has been a’stay at home parent.’ His wife is a British citizen, and she earns enough to support the family. Javier may believe he requires CSI because he is not currently employed and is not a family member of an employed EEA national (because British citizens are not included in the definition of “EEA national”). He does not, however, require CSI because he obtained permanent residence in 2015.
In both of these cases, the applicants would need to present evidence, such as P60 certificates, to show that they have acquired permanent residency at some point in the past.
Alternatively, if you can demonstrate that you worked hard and effectively during your education, you will be recognized as a worker rather than a student, and no CSI will be required. In some cases, part-time labor might be considered legitimate and effective work.
If you can’t rely on a previous period of residence or part-time employment, you’ll have to complete the CSI requirement.
The most obvious reason is that you were covered by private health insurance. Most people, on the other hand, were utterly uninformed of the necessity and would not have bought it.
Alternatively, if you have an EHIC card issued by your country of citizenship, this will suffice. An EHIC granted in the United Kingdom is insufficient.
Finally, if you are (or were) entitled to healthcare in your home country and they would have reimbursed the UK if you had become ill, this will satisfy the criterion. It is occasionally feasible to obtain a letter verifying coverage from your national government.
Olivia is a Swedish native who completed her Master’s degree in the United Kingdom in 2014. She studied during the academic year 2014-15 and has been working since September 2015. During her studies, she did not have private health insurance or an EHIC. However, Sweden has a publicly funded healthcare system, and if she had become unwell while studying in the UK, the Swedish government would have paid for her treatment. She can get a letter from the Swedish Social Insurance Agency confirming her coverage dates, which she can use to satisfy the CSI requirement for her study term.
Please contact us if you are thinking about applying for British citizenship and are concerned that the CSI requirement will be a barrier.
Do I need CSI if I have permanent residence?
As the reality of Brexit sets in, many EU citizens and their non-EU family members are considering naturalization as British citizens. However, a succession of Home Office guideline documents produced this year, ostensibly ‘clarifying’ how caseworkers at the department should handle naturalization petitions, has sparked significant concern. Many naive persons are likely to be caught out by this, believing that being awarded established status meant they had a “clean immigration record,” when in fact, immigration history is evaluated under different criteria for naturalization petitions, frequently with devastating results.
This controversy centered on EU citizens’ lack of comprehensive sickness insurance (CSI), a little-known regulatory need that few non-immigration lawyers were aware of. After all, why would anyone get CSI when they could utilize the NHS for free? Here, we analyse the issue and consider potential solutions.
Why is this such a problem?
If seeking to establish lawful residency on a self-sufficient or student basis, UKVI guidance now makes it clear(er) that EU nationals (and occasionally their family members) should have had private health insurance.
Many people who have been given settled status were under the impression that being granted settled status meant the Home Office was pleased with their legal residency for the previous five years (or three years if married to a Brit). In terms of immigration history, established status was seen as a “clean bill of health” by many. As a result, many people have applied to naturalize as British citizens, often with misplaced confidence. If they are depending on a time of residence as a’self-sufficient’ or’student,’ their naturalization applications may be denied unless they have CSI.
Furthermore, in addition to having lived in the United States for five (or three) years, there is a further criterion to be of ‘good character.’ UKVI caseworkers are given specific policy guidance on how to interpret this ostensibly subjective and ill-defined phrase. Immigration-related difficulties, such as a failure to ‘comply with the EEA Regulations’ within the past 10 years, are one component of good character.
So, confusingly, you have one rule saying you must have resided here lawfully for five years, but then, lo and behold, you have another requirement buried deep inside UKVI advice! It’s a prerequisite that you’ve lived here legally for ten years.
Why does the Home Office expect EU nationals to have CSI?
The necessity for EU nationals to have CSI is stated in regulation 4 of the EEA Regulations, which states that you must have CSI to be classified as a “self-sufficient person” or “student.”
Prior to the EU Settlement Scheme, most EEA nationals asking for naturalization had to apply for a permanent residency card, and if they relied on being self-sufficient or a student for part of their qualifying time, they would have had to deal with the CSI issue. For most EEA nationals, obtaining a permanent residency certificate was a prerequisite to filing for naturalization.
However, because the permanent residency application only cost £65, being denied was not the end of the world, and if you were successful, you could be confident in your naturalization application, at least for the five (or three) year qualifying period.
How can I meet the residence requirements for settled status, yet fail the residence requirements for naturalisation?
The EU Settlement Scheme the mandatory registration system that received over 4 million applications up until August 2020 has its own set of rules. All the Home Office requires to qualify for indefinite leave to remain under the EU Settlement Scheme is that you have lived in the UK for five years in a row. If you have, you will be granted established status, which is a powerful kind of indefinite leave to remain if you have not committed any serious crimes (ILR).
As a result, the eligibility requirements for settled status are far more lenient than those for permanent residence and a permanent resident card. In general, this is a good thing.
The situation becomes more complicated for those who have been given established status but have never considered applying for a permanent residency card. These individuals frequently desire to take the next logical step in securing their status by applying to naturalize as British citizens (most become eligible after holding settled status for one year, although if married to a British citizen, you can apply as soon as you are granted ILR).
To be eligible for naturalization, you must establish that you have not broken any immigration laws in the five years prior to your application (or within a three-year period if married to a British citizen). The instructions state unequivocally that:
‘…as this is not a requirement of the EU Settlement Scheme, this grant of settled status (also known as indefinite leave to come or remain) will not indicate that they were here lawfully under the EEA Regulations during that time, as defined by the British Nationality Act 1981.’
As a result, even if you met the residency requirements for established status, you may not meet the residency requirements for naturalization – even though the qualifying period is the same. The residency requirements for settled status and naturalization range significantly.
However, the CSI-problem does not necessarily end there. Even if you met the five-year residency requirement, you may have had a period in which you were self-sufficient or a student without CSI throughout the larger 10-year period used to assess good character. This might now be a reason for refusal, according to the guidelines.
What qualifies as CSI?
CSI is defined as “any form of insurance that will cover the expense of the bulk of medical treatment they may get in the United Kingdom,” according to Home Office guidance. An EHIC card is allowed, but only if it was issued by a member state of the European Union other than the United Kingdom.
I did not have CSI. What can I do?
I’ll get to the topic of ‘discretion’ in a moment, but before you walk down that path, double-check that you can’t establish that you’ve been a legitimate resident here all along. Finding an alternative base is very dependent on your individual circumstances. However, here are some current ways in which we have assisted our clients in overcoming the problem.
You may have obtained a right of permanent residence in the UK if you had been a resident in the UK for some time previous to the problematic period. You do not ‘apply’ for permanent residence under EU law; nevertheless, you may apply (or may have applied) for a permanent residency card. That card, however, did not ‘grant’ you the right to permanent residence; it only proved that you already had it.
To be clear, even if you did not apply for a permanent residency card, you may have already obtained a permanent resident right.
If you were a qualified person for five years before to the problematic period (for example, by working and/or being self-employed), you will have obtained a right of permanent residence. You are no longer required to obtain CSI after you have a right of permanent residency.
Case study: Raoul
Raoul, a Frenchman, arrived in the United Kingdom in July 2009. For more than five years, he worked as a greeter. From 2015 until 2017, Raoul was unemployed. Raoul never applied for a green card or a permanent residence permit. In March of this year, he was granted established status. He just applied to naturalize, but the Home Office is now inquiring about Raoul’s position between 2015 and 2017, as well as whether he had CSI at that time.
Raoul would have obtained permanent residence after working for five years in this scenario, thus by July 2014. Raoul has not been absent for more than two years since then, and hence has not lost his permanent residence. It makes no difference that he did not apply for a permanent residency card; he must now establish that he obtained permanent residence and that he has not lost it afterwards. The ‘CSI dilemma’ therefore vanishes, because a person with a permanent address does not require CSI.
It’s possible that you have (or had) a family member on whom you can rely to secure your right to stay during the difficult moment.
For example, you may have a family member who was a ‘qualified person’ throughout the time period in issue and obtained lawful residency as a result of their relationship with you. Perhaps a member of your family had already obtained a permanent residence permit (regardless of whether they applied for a permanent residence document).
If you fall into the category of what is frequently referred to as a ‘close family member,’ you are more likely to benefit. This includes spouses, children under the age of 21, and parents who are financially reliant on them.
If you were a ‘extended family member,’ you would need to have been’recognised’ as such at an early date by being supplied the necessary papers in order to profit in this way.
Case study: Ana-Maria
Ana-Maria is now worried that the time between October 2014 and January 2017 may be used against her if she files for naturalization.
Despite the fact that Ana-Maria did not have CSI throughout this time, she can show that she was legally present in the country thanks to her mother. Ana-Maria is considered a ‘close family member’ of her mother (who is also an EU citizen) and does not need to prove that she was ‘dependent’ on her mother because she was under 21 at the time.
As a result, the fact that she did not possess CSI throughout this time is irrelevant. She will, however, need to prove her relationship with her mother as well as the fact that her mother worked during the time period in question.
An EU national or a member of their family is eligible to stay in the UK for up to three months under Regulation 13 of the EEA Regulations. There is no requirement that the person be a ‘qualified person’ for the first three months, thus you should not need to have held CSI during that time.
What if you left the UK for a vacation or a brief stay in your native country, then returned to the UK during the troublesome period’? Is a new three-month right to reside triggered as a result of this? It appears to be the case by law. Getting that three-month ‘grace period’ re-triggered could make all the difference, depending on your circumstances.
A word of caution, however. We previously raised this issue, and the Home Office sent the matter to their ‘policy team.’ They don’t appear to like this technique, since our application has been’sitting’ for quite some time. We were eventually permitted, but because we had bolstered our case with a ‘discretion’ argument (see below), we don’t know which argument won (unfortunately, they don’t tell you what your winning argument was!). I would probably advise against using this argument unless it is as a backup.
CSI and discretion
If all else fails, you can try to persuade the Home Office to overlook your lack of CSI by using judgment. If you say you don’t have CSI on your naturalization application, you must explain why.
The guidance makes it clear that the caseworker must examine whether he or she should ‘use discretion’ and overlook any lack of CSI. Regrettably, the advice fails to include the good aspects that could work in your favor.
If you were previously denied a permanent residence card due to a lack of CSI and did not receive CSI afterward, you would require ‘compelling grounds to exercise discretion,’ according to the guidance.
While there is a risk of over-analyzing terms that are perhaps inadequately articulated, the following is what I would extract from this section of the guidance:
- If you were previously denied CSI at the permanent residence card stage and then failed to obtain CSI after this denial, you are likely to be in trouble because you will need to provide ‘compelling grounds.’ It’s unclear what would qualify as compelling grounds, but you’d need a very excellent (perhaps extraordinary) cause to refuse CSI in these circumstances.
- If you were previously denied CSI at the permanent residence card stage and then gained CSI as a result of this, you are clearly in a better position and would not require compelling grounds.
Unfortunately, the guidance does not provide enough clarity for what I believe to be the largest group of people concerned about this issue EU nationals and family members who never applied for a permanent residence document but were recently granted settled status and were completely unaware of the CSI requirement. It’s unclear how these people’s applications will be handled.
By establishing a ‘compelling grounds’ criteria for this small group of people who were denied CSI after being denied a permanent residency certificate, a lower bar must be set for those who were simply unaware of the CSI requirement.
Based on my understanding of the guidance and some anecdotal data, the following summarizes my own thoughts on how to approach the subject of discretion:
- A CSI offense in the five (or maybe three) years leading up to the application date is more serious than one in the remaining ten years.
- If you were previously denied a permanent residence card because of a CSI issue and did not receive CSI afterward, you would need some significant mitigation (and evidence) to overcome this.
- Make a good argument for discretion if you’re going to dispute it. If you were just unaware of the CSI rule, it may be beneficial to explain any personal reasons for your inability to comprehend the rule. You may also want to submit further proof to demonstrate that you are a ‘nice person’ in general? Can you, for example, show that you have made a “good contribution” to UK society? Remember that your application will land on the desk of a UKVI caseworker who is working under similar conditions. Because there appears to be a lot of discretion, persuade the caseworker to grant your request!
Final thoughts
- Have you looked to see if you had a right of residence through some other means throughout the difficult period, such as being a ‘family member’?
- If it fails, how long must you wait until the ‘difficult time’ is no longer inside the relevant computation period? The shorter the wait, the stronger the case for waiting and applying later.
- Is your issue period within the five (or three) year time frame, or later in the ten-year time frame? If it occurs at a later time, it appears to be less of an issue.
As always, the legal analysis above is my own take on the CSI issue, based on a lack of clarity in Home Office guidance and anecdotal evidence. Others may hold a different point of view.
If you believe you may want assistance in this area, we provide a number of immigration legal services to assist you. This includes comprehensive guidance, document review, and complete representation, in which we handle the whole application process on your behalf. Please get in touch with us as soon as possible.